Provider Demographics
NPI:1750718565
Name:WILLIAMS, ERIK D SR
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:D
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 E MOUNT AIRY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1147
Mailing Address - Country:US
Mailing Address - Phone:215-242-1204
Mailing Address - Fax:215-248-6055
Practice Address - Street 1:633 E MOUNT AIRY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1147
Practice Address - Country:US
Practice Address - Phone:215-242-1204
Practice Address - Fax:215-248-6055
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-027201-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist